Home Health Care Commercial Insurance
Home health care is defined as skilled nursing care and certain other health care services that you get in your home for the treatment of an illness or injury. At last count, there were 12,445 Medicare-certified home health agencies and 20,660 other home care companies in the United States. Indeed, home health care is the fastest growing sector in the industry serving those who require elderly health care. This is due to a number of reasons:
- The enactment of Medicare in 1965
- The 1987 revisions to Medicare, which introduced reimbursement to home care agencies
- The continual growth of our aging population
- The increased life expectancy of seniors
- The willingness to decrease the length of hospital stays and provide early discharge of many patients to home care
Classification of Home Care Agencies
Freestanding proprietary agencies provide most formal home care. Home care is also provided by hospital-based agencies, with nonprofit public and private health agencies providing a smaller portion. There are three major classifications of home health care agencies:
Home health care provides some unique challenges for those working in this environment. Not only are many of the same risks associated with hospitals and nursing homes present, but household related hazards such as poor air quality, toxic substances, and aggressive pets may also be issues. Additionally, the homecare health setting cannot be controlled. Finally, many home health care providers may have limited training and experience in providing patient safety and there is no direct supervision of their daily activities.
Some of the risks associated with home health care are:
General security/personal safety hazards:
- Unsafe neighborhoods
- Violence from patients or family members
- Potentially dangerous household pets
When it comes to home healthcare, fraud and theft are major areas of concern. Every effort must be made to prevent fraud and theft, as occurrences not only affect the well-being of patients, but can also harm a client’s reputation.
Health care fraud occurs when false information is represented as truth. Perpetrators exploit patients by entering into their medical records false diagnoses of medical conditions they do not have, or of more severe conditions than they actually do have. Then bogus insurance claims can be submitted for payment.
Home healthcare fraud claims also involve intentional incorrect billing of Medicare. According to the Senior Medicare Patrol (SMP), “An estimated $250 million is lost to purposeful health care fraud each year.” Examples of fraud that may occur include: